Mental health impact of COVID-19 on family doctors in Canada: one year after.

Context: A year after the pandemic outbreak, primary care providers continue to face extreme psychological pressure. This study gauges the mental health and burnout levels of family physicians during the third wave of the COVID-19 pandemic in Canada. Objective: Assess the levels of personal, professional and patient-related burnout of family physicians (FPs) in the response to the pandemic and explore demographic and work-related factors that may influence burnout levels. Study Design: Online, self-report survey administered between April 7 and May 10, 2021. Setting or Dataset: The College of Family Physicians of Canada's (CFPC) list of all active members was used to reach family physicians in diverse practice settings in all Canadian provinces and territories. Population studied: All active CFPC family physician (FP) members were included. Family medicine trainees and members with primary addresses outside Canada were excluded. Most FPs in Canada are CFPC members; 39,991 FPs received survey invitations; 3,409 replied, for an overall response rate of 9%. Outcome Measures: The study used the Copenhagen Burnout Inventory (CBI) which measures the level of personal, work-related and patient-related burnout. As well, question asking about FP's overall sense of well being and personal wellness which were asked in a previous survey, a year prior, were incorporated to allow for longitudinal comparison. Results: 15% of FPs reported feeling burned out and thinking of, or have taken, a break from work, three times more than last year. More than one-fifth of FPs currently experience high or severe personal (22%) and work-related (21%) burnout, while 13% report the same levels of patient-related burnout. Female FPs report higher levels of personal burnout (26%, 17%) and work-related burnout (23%, 16%) than male FPs. Generations Y (30%) and X (25%) are experiencing higher levels of personal burnout than Baby Boomers (14%) and Traditionalists (2%). Conclusions: Roughly 1-in-4 FPs in Canada are currently experiencing high or severe personal and work-related burnout. Compared with the survey results a year prior, the numbers are climbing rapidly, reflecting the serious challenges FPs facing during the pandemic. This study was designed to contribute to a better understanding of the extent of the problem, contributing factors and to assist in considering approaches to build effective support systems to improve the mental health of FPs.

Do learners implement what they learn? Commitment-to-change following an interprofessional palliative care course.

BACKGROUND: Palliative care educators should incorporate strategies that enhance application into practice by learners. Commitment-to-change is an approach to reinforce learning and encourage application into practice; immediately post-course learners commit to making changes in their practices as a result of participating in the course ("statements") and then several weeks or months later are prompted to reflect on their commitments ("reflections"). AIM: Explore if and how learners implemented into practice what they learned in a palliative care course, using commitment-to-change reflections. DESIGN: Secondary analysis of post-course commitment statements and 4-months post-course commitment reflections submitted online by learners who participated in Pallium Canada's interprofessional, 2-day, Learning Essential Approaches to Palliative Care (LEAP) Core courses. SETTING/PARTICIPANTS: Primary care providers from across Canada and different profession who attended LEAP Core courses from 1 April 2015 to 31 March 2017. RESULTS: About 1063 of 4636 learners (22.9%) who participated in the 244 courses delivered during the study period submitted a total of 4250 reflections 4 months post-course. Of these commitments, 3081 (72.5%) were implemented. The most common implemented commitments related to initiating palliative care early across diseases, pain and symptom management, use of clinical instruments, advance care planning, and interprofessional collaboration. Impact extended to patients, services, and colleagues. Barriers to implementation into practice included lack of time, and system-level factors such as lack of support by managers and untrained colleagues. CONCLUSIONS: Examples of benefits to patients, families, services, colleagues, and themselves were described as a result of participating in the courses.

How do family physicians measure blood pressure in routine clinical practice? National survey of Canadian family physicians.

OBJECTIVE: To describe the techniques currently used by family physicians in Canada to measure blood pressure (BP) for screening for, diagnosing, and treating hypertension. DESIGN: A Web-based cross-sectional survey distributed by e-mail. SETTING: Stratified random sample of family physicians in Canada. PARTICIPANTS: Family physician members of the College of Family Physicians of Canada with valid e-mail addresses. MAIN OUTCOME MEASURES: Physicians' self-reported routine methods for recording BP in their practices to screen for, diagnose, and manage hypertension. RESULTS: A total of 774 valid responses were received, for a response rate of 16.2%. Respondents were similar to nonrespondents except for underrepresentation of male physicians. Of 769 respondents, 417 (54.2%) indicated that they used manual office BP measurement with a mercury or aneroid device and stethoscope as the routine method to screen patients for high BP, while 42.9% (330 of 769) reported using automated office BP (AOBP) measurement. The method most frequently used to make a diagnosis of hypertension was AOBP measurement (31.1%, 240 of 771), followed by home BP measurement (22.4%, 173 of 771) and manual office BP measurement (21.4%, 165 of 771). Ambulatory BP monitoring (ABPM) was used for diagnosis by 14.4% (111 of 771) of respondents. The most frequently reported method for ongoing management was home BP monitoring (68.7%, 528 of 769), followed by manual office BP measurement (63.6%, 489 of 769) and AOBP measurement (59.2%, 455 of 769). More than three-quarters (77.8%, 598 of 769) of respondents indicated that ABPM was readily available for their patients. CONCLUSION: Canadian family physicians exhibit overall high use of electronic devices for BP measurement, However, more efforts are needed to encourage practitioners to follow current Canadian guidelines, which advocate the use of AOBP measurement for hypertension screening, ABPM and home BP measurement for making a diagnosis, and both AOBP and home BP monitoring for ongoing management.

Self-management, health service use and information seeking for diabetes care among Black Caribbean immigrants in Toronto.

OBJECTIVE: The objective of this research was to explore self-management practices and the use of diabetes information and care among Black-Caribbean immigrants with type 2 diabetes. METHOD: The study population included Black-Caribbean immigrants and Canadian-born participants between the ages of 35 to 64 years with type 2 diabetes. Study participants were recruited from community health centres (CHCs), diabetes education centres, hospital-based diabetes clinics, the Canadian Diabetes Association and immigrant-serving organizations. A structured questionnaire was used to collect demographics and information related to diabetes status, self-management practices and the use of diabetes information and care. RESULTS: Interviews were conducted with 48 Black-Caribbean immigrants and 54 Canadian-born participants with type 2 diabetes. Black-Caribbean immigrants were significantly more likely than the Canadian-born group to engage in recommended diabetes self-management practices (i.e. reduced fat diet, reduced carbohydrate diet, non-smoking and regular physical activity) and receive regular A1C and eye screening by a health professional. Black-Caribbean immigrant participants were significantly more likely to report receiving diabetes information and care through a community health centre (CHC) and nurses and dieticians than their Canadian-born counterparts. CONCLUSIONS: CHCs and allied health professionals play an important role in the management of diabetes in the Black-Caribbean immigrant community and may contribute to this group's favourable diabetes self-management profile and access to information and care. Additional research is necessary to confirm whether these findings are generalizable to the Black-Caribbean community in general (i.e. immigrant and non-immigrant) and to determine whether the use of CHCs and/or allied health professionals is associated with favourable outcomes in the Black-Caribbean immigrant community as well as others.

Learner Experiences Matter in Interprofessional Palliative Care Education: A Mixed Methods Study.

CONTEXT: Interprofessional collaboration is needed in palliative care and many other areas in health care. Pallium Canada's two-day interprofessional Learning Essential Approaches to Palliative care Core courses aim to equip primary care providers from different professions with core palliative care skills. OBJECTIVES: Explore the learning experience of learners from different professions who participated in Learning Essential Approaches to Palliative care Core courses from April 2015 to March 2017. METHODS: This mixed methods study was designed as a secondary analysis of existing data. Learners had completed a standardized course evaluation survey online immediately post-course. The survey explored the learning experience across several domains and consisted of seven closed ended (Likert Scales; 1 = "Total Disagree", 5 = "Totally Agree") and three open-ended questions. Quantitative data were analyzed using descriptive statistics and Kruskal-Wallis non-parametric test tests, and qualitative data underwent thematic analysis. RESULTS: During the study period, 244 courses were delivered; 3045 of 4636 participants responded (response rate 66%); physicians (662), nurses (1973), pharmacists (74), social workers (80), and other professions (256). Overall, a large majority of learners (96%) selected "Totally Agree" or "Agree" for the statement "the course was relevant to my practice". A significant difference was noted across profession groups; X2 (4) = 138; p < 0.001. Post-hoc analysis found the differences to exist between physicians and pharmacists (X2 = -4.75; p < 0.001), and physicians and social workers (X2 = -6.63; p < 0.001). No significant differences were found between physicians and nurses (X2 = 1.31; p = 1.00), and pharmacists and social workers (X2 = -1.25; p = 1.00). Similar results were noted for five of the other statements. CONCLUSION: Learners from across profession groups reported this interprofessional course highly across several learning experience parameters, including relevancy for their respective professions. Ongoing curriculum design is needed to fully accommodate the specific learning needs of some of the professions.

Practice Profiles and Patterns of Ontario Family Medicine Residents 5 Years After Residency Examinations: An Exploratory Study.

BACKGROUND AND OBJECTIVES: The primary goal of family medicine residency training is for graduates to provide high-quality, safe, and effective patient care for the population they serve when they enter practice. This study explores (a) the practice profiles, 5 years into practice, of residents who completed family medicine training in Ontario, Canada; and (b) relationships between performance on the College of Family Physicians of Canada's (CFPC) Certification Examination in Family Medicine and quality of care provided 5 years into practice. METHODS: We performed a retrospective study with secondary data analysis. We merged CFPC examination data sets with the ICES (Institute for Clinical Evaluative Sciences) administrative database. We included physicians who passed the examination between the years 2000 and 2010 and practiced in Ontario after graduation. Practice profile indicators included practice type, continuity and comprehensiveness of care, patient rostering and panel size, and rurality index. We explored 11 indicators related to management of diabetes and cancer screening. RESULTS: We included a total of 1,983 physicians in the analyses. Five years after the examinations, 74.3% of the physicians were working in major urban centers, and 67.3% of the physicians were providing comprehensive primary care. We noted significant differences across the six medical schools in multiple practice profile indicators, and three indicators showed significant differences across the examination score quintiles. CONCLUSIONS: Graduates of Ontario family medicine residency programs were providing care to a broad spectrum of the population 5 years after passing the examination, and they performed similarly across quality-of-care indicators regardless of examination scores.

The Use of Statistical Process Control Charts to Evaluate Interprofessional Education Sessions Embedded Into a Pediatric Emergency In situ Resuscitation Program.

STATEMENT: The rigorous evaluation of simulation in healthcare to improve resuscitations and team functioning can be challenging. Statistical process control (SPC) charts present a unique methodology to enable statistical rigor when evaluating simulation. This article presents a brief overview of SPC charts and its advantages over traditional before and after methodologies, followed by an exemplar using SPC to evaluate an in situ team training program with embedded interprofessional education sessions.